Member Admissions
Ready to begin services? Complete our online admission form or download the paper packet — whichever is easiest for you.
Begin Admission
Complete the secure online admission form to begin services. A member of our admissions team will follow up to schedule a start-of-care visit.
The online form opens in a new tab. The paper packet is a 36-page fillable PDF.
Fill out the secure admission form online — no printing or faxing required.
Prefer paper? Download the fillable PDF, type your info, sign, and fax to 317-887-6044.
An admissions team member contacts you to schedule a start-of-care visit at a time that works.
Patient Consents & Forms
Review and sign each document below to complete the admission process. Each opens in a new tab for secure electronic signature.
Review and sign the patient consent and authorization form.
Provide your designated representative information for care coordination.
Provide emergency preparedness and health care proxy information.
Provide your insurance and coverage information for billing.
Review and sign the patient financial authorization form.
Review and acknowledge all admission documents.
Sign the final acknowledgment to complete the admission process.
